Provider Demographics
NPI:1427805175
Name:CRONIN DERMATOLOGY & SKIN CANCER CENTER OF KENT ISLAND, LLC
Entity type:Organization
Organization Name:CRONIN DERMATOLOGY & SKIN CANCER CENTER OF KENT ISLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HYLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-685-3629
Mailing Address - Street 1:1630 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2793
Mailing Address - Country:US
Mailing Address - Phone:304-685-3629
Mailing Address - Fax:
Practice Address - Street 1:1630 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2793
Practice Address - Country:US
Practice Address - Phone:304-685-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRONIN DERMATOLOGY AND SKIN CANCER CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-01
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty